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Position(s) Applied For

Date

Name

First Last

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email

Type of Employment Desired*

Full-Time
Part-Time
Temporary

Days & Hrs. able to work (if NOT Mon. through Fri., 8am to 6pm):

What date are you available to start work?

Are you over 18 years of age?

Yes
No

If no, please list your age.

Are you legally eligible for employment in the United States?

Yes
No

Are you willing to undergo Pre-Employment Drug Testing?

Yes
No

Do you have a valid driver's license with a clean driving record?

Yes
No

If no, please explain:

During the last 10 yrs., have you ever been convicted of a crime?

(a “yes” answer will not automatically disqualify you from employment. Rather, such factors as age and date of conviction, seriousness and nature of the crime, and rehabilitation will be considered)

Yes
No

If yes, please explain:

Education

Please include high school, college, and/or trade school experience.

Type of School	Name of School	Location	Last Grade/Year Completed	Major & Degree

Skills and Qualifications: Summarize any training, skills, areas of specialization or major interest that may qualify you as being able to perform job-related functions in the position for which you are applying.

United States Military Training: Summarize any job-related training you received.

Professional Licenses and/or Certifications: If licensed, registered, or certified, list:

Type	State Issued	Date Issued

Employment History

Please complete this section and do not write "see resume." Beginning with the most recent, please list your last three places of employment, including the following information for each: company name and phone, a description of the job including duties, skills, and tools used, employment start and end dates, starting and ending pay rates, your reason for leaving, and a person of contact and their phone number.

If you do not want us to contact any of the above listed current or former employers, please list below and state the reason you do not want each contacted.

References

Please provide three non-relative references that can attest to your character, work ethic, and work-related skills.

Name	Phone

Applicant Statement

I certify that all information I have provided in order to apply for and secure work with Alien Car Care is true, complete and correct. If any information provided by me is found to be false, incomplete, or misrepresented in any respect, it will be sufficient cause to cancel further consideration of this application, or immediately discharge me from Alien Car Care service, whenever it is discovered. I expressly authorize Alien Car Care and it’s agents, without reservation, to contact and obtain information from all references, employers, public agencies, licensing authorities, and educational institutions and to otherwise verify the accuracy of all information regarding me in this application, resume, or job interview. I hereby waive any and all rights and claims I may have regarding Alien Car Care or its agents seeking, gathering, and using such information in the employment process and all other persons, corporations or organizations for furnishing such information about me. I understand that Alien Car Care does not unlawfully discriminate in employment, and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by applicable local, state or federal law. I understand that completion of this Application For Employment does not guarantee that Alien Car Care has employed me. I certify that I have read, fully understand and accept all terms of the foregoing Application Statement.

Signature and Date

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